- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.36 / $439.73 / $717.31
| Facility | | $225.36 | $439.73 | $717.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.62 / $225.36 / $261.08
| Professional | | $211.62 | $225.36 | $261.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.55 / $384.76 / $486.44
| Facility | | $321.55 | $384.76 | $486.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.56 / $657.40 / $1,265.71
| Facility | | $348.56 | $657.40 | $1,265.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.80 / $334.90 / $401.25
| Professional | | $329.80 | $334.90 | $401.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $404.00
| Professional | | $30.00 | $30.00 | $404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $164.90 / $274.83
| Professional | | $115.43 | $164.90 | $274.83 |